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HomeMy WebLinkAboutApp-Permit-ComplianceNo.&0DC-(S-442_5_ ell '/5-- _�>o J�' C®NIM®N 1T1I f)r MASSACHUS TTS FEE16.5:00 8100 r�(1 / u / �` � rd of Health, r A:gj '10Ln_ , MA. DISPOSAL' SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade�bandonO - 0 Complete System ndividual Components Location l5 Owner's Name z Map/Parcel# /!%��o ��l� Address /6 T Lot# Telephone# Installer's Name Designer's Name C44_e_&� Address Address Telephone# C6;?W__ Telephone#— 3 _ Type of Building Dwelling - No. of Bedrooms Other - Type of Building _ No. of persons Lot Size sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) 14gpd Calculated design flow Design flow provided ss_3 gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation t DESCRIPTION OF REPAIRS OR ALTERATIONS e G49, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agre to not to place the system in opera ' until a Certificate of Compliance has been issued by the Board of Health. i Signed Date a Inspections 11 No. f7044IDC_(S4q-.-5- �`y va+1//'FEE 15-5-, 00 COMMONWFAI.T14 OF MASSAC14USETTS 06 Board of Health, yt t rvtourw CERTIFICATE Of COMPLIANCE Description of Work: individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( )> Upgraded„(,.} -,Abandoned O by: at ✓ �� _ has been installed n accordant� with the p to sof 310 CMR 15.00 (Title 5) and t e proved design plans/as-built plans relating to application No. /:�--t%.,t, dated % r' .Approved Design Flow(gp(') Installer k ( 4? C f Ir Designer: �:- 2i1' %'1 (r a, /,.4-( Spector: /V bJ Ll (C—fiWl Date:rP- The issuance of this permit shall not be construed as a guarantd that the system will function as designed. 3 r -n_ z:.c"'060 c`e�c') c 1C"'_0o :i-..<2oc) 4.'U O.GCS r"C0; c d'. 00"), OooDt tdODOc�000OQi�. �03�'7ilC0"�C'}VQ LSCC C�G�C�u.0 No. _9�0 Rix- (15- 44 2--5, C fMS E `f' M 6)2.-C t+A-I11T- FEE A - ' COMMONWEALTH Of MASSACHUSETTS dz4(�`oo Board of Health, Y/3 ©U?`�# , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade -Abandon ( ) an individual sewage disposal system at %� < ����.t-t.4 4� l ate. _.�f t-[.G.e as described in the application for Disposal System Construction Permit No. �> dated - P Provided: Construction shall be completed wt to thears o .the date of this ermit. -All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA Date /� Board of Health G No.:BOHDC-15-4425 Commonwealth of Massachusetts Fee $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Upgrade-Individual Component(s) Locatiou: 15 LEWIS BAY BLVD,WEST YARMOUTH, MA 02673 Owner: DURKIN JANET A TRS Map/Parcel#: 016.50 DURKIN MICHAEL J TRS 15 LEWIS BAY BLVD WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer CHASE&MERCHANT DOWN CAPE ENGINEERING,INC. P.O. BOX 5 DENNISPORT, MA 02639 939 ROUTE 6A Phone: YARMOUTHPORT,MA 02675 508-362-4541 Type of Building:Dwelling Lot Size: 16,117.00 Acres Dwelling-No.of Bedrooms:4 Garbage Grinder: Ot6er Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:07/10/2015 Number of Sheets: 1 Cafeteria: Title:TITLE 5 SITE PLAN 15 LEWIS BAY BLVD Revision Date: Design Flow(min.required):440 gpd Catculated design flow:440 gpd Design flow provided:553 gpd Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/19/2010 - DANIEL OJALA,P.E. DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK,DBOX,68'X - 11'X 6"LEACH FIELD The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aarees not to olace in ooeration until a Certiflcate of Comuliance has been issued bv the Board of Heakh. Signed Date Inspections � a � � � . � . Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT ass.00 � Permission is herby granted to; CHASE&MERCHANT INC., P.O. BOX 5, DENNISPORT, MA 02639 To perform:Upgrade an individual sewage disposal system. Owner: DIJRKIN JANET A TRS DURKIN MICHAEL J TRS 15 LEWIS BAY BLVD WEST YARMOUTH,MA 02673 Location: 15 LEWIS BAY BLVD,WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-15-4425,Dated: September 18,2015 i � Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. I CONDITIONS: i 1. SEPTIC DISPOSAL-REPAIR-EXISTING 1500 GAL SEPTIC TANK, DBOX,68'X 11'X 6"LEACH FIELD 2. BOH TO INSPECT REMOVAL OF FAILED SYSTEM PRIOR TO INSTALLATION OF LEACH FIELD Bruce G. urp y, MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO Health Director/Assistant Health Director The issuance of this permit shall not be construed as a guarantee that the system will function as designed.